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Lower FPM Extraction Timing — ORE Part 1 MCQ

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ModeratePaediatric DentistryLower FPM Extraction TimingORE Part 1

An 8-year-old child has severe molar-incisor hypomineralisation affecting all four first permanent molars. Two lower first permanent molars have extensive post-eruptive breakdown and remain symptomatic despite restoration attempts. Following orthodontic assessment, planned extraction is recommended. Which timing principle is most appropriate for extraction of a lower first permanent molar?

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Correct answer: E — Extract at about 8–10 years, when the second permanent molar is unerupted and its root bifurcation is calcifying

The best answer is E. In the lower arch, the timing of first permanent molar extraction is important because spontaneous mesial eruption of the second permanent molar is less predictable than in the upper arch. The favourable window is approximately 8–10 years, while the second permanent molar remains unerupted and shows radiographic calcification of its root bifurcation. This maximises the prospect of a good spontaneous occlusal position, subject to the overall orthodontic assessment. Extraction before age 8 may precede useful assessment of developing third molars and is not the usual planned window. Delaying until after second permanent molar eruption increases the risk of mesial tipping, rotation and poor contacts. Facial growth completion is irrelevant, and dental development should not be ignored.

Reference: Royal College of Surgeons of England, Faculty of Dental Surgery. A Guideline for the Extraction of First Permanent Molars in Children, section: Ideal timing of first permanent molar extraction, 2014. https://www.rcseng.ac.uk/-/media/files/rcs/fds/publications/a-guideline-for-the-extraction-of-first-permanent-molars-in-children-rev-sept-2014.pdf?la=en